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1997-98 Academy Text Supplement

Chapter 10

The Mental Health Impact of Crime: Fundamentals in Counseling and Advocacy

Statistical Overview

As much as 10 to 20 percent of mental health care expenditures in the United States may
be attributable to crime, primarily for victims treated as a result of their victimization.
These estimates do not include any treatment for perpetrators of violence. (Miller, T.,
Cohen, M., & Wiersema, B. (1996, February). Victim Costs and Consequences: A New Look.
Washington, DC: National Institute of Justice, U.S. Department of Justice.)

Mental Health Impact of Child Victimization

In April of 1997, the National Institute of Justice released a summary of research conducted by
Kilpatrick and Saunders at the National Crime Victims Research and Treatment Center, located
at the Medical University of South Carolina, entitled the Prevalence and Consequences of Child
Victimization. The Report's preliminary findings about the mental health impact of child
victimization are highlighted below:

Preliminary findings from the study of 4,023 adolescents and their parents indicate
that a significant number of youth have been victims of sexual and physical abuse
and have personally witnessed incidents of violence.

Extrapolating the findings of the study to the national adolescent population as a
whole suggests that of the nation's 22.3 million adolescents ages 12-17:
approximately 1.8 million have been victims of a serious sexual assault; 3.9 million
have been victims of a serious physical assault; and almost nine million have
witnessed serious violence. Nearly two million appear to have suffered (and over
one million still suffer) from Post-traumatic Stress Disorder (PTSD). About 3.4
million have been drug or alcohol abusers as well.

Previous research has indicated that at some point in their lives, nearly 30 percent
of sexual assault victims developed -- and almost 20 percent still suffered from --
PTSD. By comparison, 6.2 percent of adolescents who were not sexually
assaulted, but might have been victimized in other ways, developed PTSD, and
3.6 percent still had PTSD.

Among adolescents who have been physically assaulted, 23.4 percent developed
PTSD and 14.8 percent still suffered from it, while 10.8 percent of non-victims
of physical assault developed, and 4.5 percent still had PTSD.

Among witnesses to violence, 15 percent developed PTSD, compared to 3.3
percent of surveyed youths who had not witnessed violence.

The researchers note that confirmation of the study's hypotheses that a correlation
exists between victimization experiences, PTSD, and delinquency must wait until
completion of data analysis. However, preliminary findings indicate the
significance of: personal victimization as a risk factor for major mental health
problems; abuse of alcohol as a means of coping with PTSD; and substance abuse
as a precursor of delinquent behavior.

Counselor Confidentiality Issues

In its 1996 Report to Congress, the Violence Against Women Office found:

As of December 1995, 27 states and the District of Columbia had enacted statutes
that protect from disclosure, to differing degrees, confidential communications
that arise from the relationship between sexual assault and/or domestic violence
victims and their counselors.

State courts have reached different conclusions about the constitutionality of
statutes providing totally absolute or semi-absolute privileges. The United States
Supreme Court has not granted certiorari in any of the state court decisions
concerning the constitutionality of testimonial privileges for communications
between victims and counselors, and has not addressed the issue of whether such
an absolute testimonial privilege is constitutional.

State statutes differ in the degree to which confidential communications are
protected from disclosure. Some state statutes provide a totally absolute privilege
where disclosure is not permitted under any circumstances. Others provide a
semi-absolute privilege where disclosure may be permitted only under specified
circumstances when disclosure serves the public interest. Still others provide a
qualified privilege where disclosure is permitted after certain requirements are met
or balancing tests are employed.

While states have enacted statutes establishing testimonial privileges for many
confidential communications, including those between psychotherapists or
psychologists and their patients, the federal government has not enacted such
legislation. (1996 Report to Congress. (1996). Washington, DC: Violence Against Women
Grants Office, U.S. Department of Justice.)

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